You can say it kindly. You can say it with a hipster ironic grin while wearing sensible shoes. You can say it forcefully and feel bad about it later. You can craft an argument with references and citation and voices more respected than yours. You can add “Fuck You” at the end of saying it. You can dramatically enact it through dance, vulnerable in your sweat letting them see your body if that’s what they need to stay interested. You can pass it quietly in a note in hopes of it reaching its intended audience. You can just say it again and again and again.

You cannot make them hear you. Not if they choose not to.

Say it anyway.

Say it because you need to hear it. Because it keeps you solid and engaged and believing in yourself. Say it because it is mother fucking interesting to you and it brings you to that place of awe. Say it because you are here and this present moment shouldn’t be wasted. Say it because you do not want to self destruct or drink yourself into a stupor like so many of the people you hoped to love. Say it because when you do it reverberates in your heart and that feels good; it feels like being alive.

For now your truth can be your own. Or you can tentatively or enthusiastically find places to share it where it just might be heard. Or you can lick your wounds and revel in being misunderstood if that is what your internal teenager needs today. You can be terrified of it and keep it in a tight space for now, observing it pacing there. Maybe it is content to be contained. Maybe not, maybe it is going to irritate you every day.

I know the people you needed to hear you didn’t. They didn’t, they couldn’t, they chose not to. I know. But even then, you continued to say it, to listen to yourself. And that is really important. Keep listening to what you have to say.

Think of your voice and your breath as fun sex toys that you always have with you, cost nothing, and don’t require a trip, virtual or otherwise, to the sex store. Simple ways of making sound and directing your breath can quickly get you and your partner into another level of intensity. You just need to be brave enough to bring it out.

Ready to try?

Start with slow, deep breaths – Breathing is a cue to the body about how to channel energy. Slow deep breaths tell our bodies to relax, to open up to sensation, and for most of us a good deep breath is long overdue and just feels good. Bring in breath so that your lower belly fills up, then as you let it out imagine that your tension is melting. Deep breaths are great when your partner is focused on pleasing you and you get to lay back and receive (and can help relieve any shyness you may feel about being pleasured).

Move with your breath– Now that you are breathing deeply, you can rock your pelvis along with your breath. You may tilt your pelvis back on the in breath and tuck it forward on your out breath. These can be small gentle movements; think rocking, not thrusting at this point. There is no right or wrong with this, see what feels right for you. Just use your breath as an invitation to move your body. Let your breath deepen so that you can hear it. Don’t be surprised if your breathing starts to get faster…

Faster and deeper – As you get more turned on, your breath will change. You can help with that by consciously speeding up your breathing. Try taking in mini-gulps of air, like gasps. As you do that imagine your sensation building.

Let sound come out – If you are breathing deeply, you may naturally be making some luscious noise. Just let your mouth open, relax your jaw, and let your breath come out fully as a sigh. If that feels good, turn it into a moan. Making sound engages your whole body and keeps energy flowing, which is good for intensity. Making sound cues your partner to your pleasure and that is a huge turn on. But it is not just for your partner - I really recommend that you make sound when you masturbate too, so that you can ride your own excitement and get used to hearing yourself.

Sound = Vibration - Sound involves little vibrations. If you have ever chanted OM in yoga class, you may have experienced the resonation of sound into your belly. Using your mouth and sound creates a nice little vibration for sensitive spots. If you have your mouth on your partner for some oral play, make a little ‘MMM’ sound. Gently holding a nipple in your mouth and humming – oh yeah.

Feeling the breath - You can use your breath to create coolness or warmth on your partner’s skin. Lick a place and then blow gently on it from an inch away and watch the goosebumps rise. Lick a place and bring your open mouth close to the skin and breath out, wet, warmth. Blow like a light tickle, whisper secrets into their skin. Sensation play, no props needed.

Say it – Say “yes”, say “please’, say “oh god, don’t stop!”. Tell your partner what you are about to do. Tell your partner what you would like them to do. Using your voice can be a huge part of the fun – even the whole part if you are engaging in phone sex or just opting for a safe sex choice. This can be part of the sex play hours before you get naked together. And it can be especially fun in building anticipation with a partner who is happily restrained or blindfolded. Talking dirty is its own sexplay toolkit, and I will write more specifically about that next time…

For now, try these simple intensity boosts. If making sound feels embarrassing to you, I highly recommend you start with using breath as a gentle introduction. Play music so that you feel surrounded by sound. You can also try muffling your sounds by moaning into a pillow or an open palm over your mouth. Restricting your sound, is its own kind of play. But in any case, breath is powerful. When in doubt, take a deep breath,… let it out slowly. Enjoy.

Asking a current partner to change the rules of the relationship can be scary. If you love your partner and want to stay in relationship with them, shaking things up can feel incredibly fragile and remind you of what you stand to lose. If you are thinking about an open relationship, I hope you have spent some time asking yourself questions and gaining clarity on what it is you want, why you want it, and what you are willing to compromise.

Once you have some clarity for yourself, you may decide to approach your partner and explore making changes to your relationship agreements. Here are some tips, pulled from couples I have seen in the therapy room, for those early conversations.

Find a time when you feel close, strong and relaxed – Thinking about opening your relationship to new partners will feel vulnerable and risky, so start the conversation from a solid foundation. Be sure you will have time and privacy, that you both have had recent clear reminders of why your relationship is healthy and strong, and there are no other major life stressors drawing energy. If you have recently had a breach of trust, or communication has been painful, or you are not enjoying spending time together, this is probably not a good time to explore opening your relationship. Rather focus on strengthening what you have together so that you have a good base for adventures later.

Be prepared to hear No – Remember if you come to this with only one acceptable outcome in mind, it is less a conversation than an ultimatum. You may be very excited about this possibility, but try as best you can to actually approach your partner with curiosity. Your first conversations should be to explore the idea together, not to try and convince them. Ask questions; what do they imagine an open relationship looks like?, what would scare them about it?, what excites them?, what would it require you to change? If your partner doesn’t feel pressured or manipulated, it is more likely you will be able to revisit the topic again.

Be prepared to tell your partner how they are special to you - In thinking about adding new partners in to a relationship dynamic, It is natural for your current partner to wonder, “Am I being replaced? Am I lacking in some way or not enough for you? Will you treat me just the same as you treat other partners?” Come to the conversation able to speak to what is unique about your relationship with your current partner, what you appreciate about them, and how you see them as being different than other partners. How will you prioritize your partner? How do you see their role in your life as special?

Be prepared to talk about time management andpriorities – The truth is having more than one romantic or sexual partner requires more time. If your partner already feels squeezed into your life or both of you are barely getting through your weeks requirements as it is, you will need to think about what is realistic. What will you have to give up doing so that you time to spend with new people? What is going to take priority?

Don’t Bully or Belittle – One behavior I have seen again and again in unsuccessful conversations about open relationships, is one partner treating the other as though they are unenlightened, up tight, brainwashed, jealous – pick your patronizing insult. The results of this approach are no better than when the partner who is against an open relationship accuses the other of being slutty, immature, immoral, or worse. Relationships are about emotional needs as well as shared values. Even if the idea of monogamy no longer makes sense to you intellectually, remember that decisions about relationships and love are deeply emotional. They don’t always rely on the rational. Our relationships are not just socio/political exercises, they must be uniquely shaped by the humans in them. Be respectful of your partner’s stance and honor the emotions and vulnerability at play.

Expect this to be a long conversation – Look at this as a shared exploration. The two of you cannot figure out how you feel or what will work for you in one sitting. This will take time to develop, a series of conversations, starts and stops, re-evaluating, questioning, and even back tracking. All of this of ok, in fact it is the basis of an honest, alive, growing relationship.

I see many people in my private practice who do not want to end the relationship they are in but are interested in having other sexual or romantic partners. As polyamory and open relationships are becoming more visible, more people are wondering, is there a way I can be honest with my partner about what I am desiring? How can I even start this conversation?What will help us to be successful if we try this?

Here are some tips from my years of working with couples while they explore if an open relationship is right for them. This first article will focus on getting clarity for yourself before you even approach your partner.

First,do not start an affair. I cannot stress this enough. It is true for many people that the first time they begin to consider open relationships are when they have met an appealing new potential partner. While a new person may allow you to realize that you can love more than one person at a time; if you are seriously considering an open relationship with your current partner the first requirement will be to treat them with respect and the relationship with integrity. Open relationships are not a free for all or permission for cheating; lies are still lies. You will not be able to effectively change the rules of your relationship to allow for more openness, and the trust that this requires, when you are healing the wounds of an affair.

Be honest with yourself about what you want from your current relationship. Are you considering new partners because you are bored or unhappy with your current relationship? Are your reasons for wanting to stay with your current partner primarily practical, i.e. it would be inconvenient to divorce or separate? Can you identify things about your current partner that you love and really value about them? Are you happy being with them for who they are? A functioning open relationship will require intense honesty, respect and ongoing communication. Do you and your partner currently have those skills and want to engage MORE with each other? Are you willing to take some time to first build the foundation of this relationship before adding other partners? If not, this brings us to our next tip.

Don’t use an open relationship as a way to break up slowly. If you are not really happy with your current partner and are desiring a way to pull away from that relationship, it will be better to be honest about this – with yourself and your partner. A struggling relationship is not likely to be fixed by opening up to other partners, nor are other partners necessarily going to ease the blow of a break up. More often it just complicates things further and makes it so you really don’t have the energy or the time to work on problems with your current partner. So before beginning a conversation with your partner about opening the relationship, ask yourself, am I really asking for this because I feel it will end the relationship so that I can be free?

Ask, are you willing to let someone else share in your sexual decision-making? While there are hundreds of ways to structure open relationships and sexual agreements with partners, if you are thinking about expanding a relationship with a current partner, that implies that you will work as partners to create rules and agreements that work for both of you. This requires negotiation, consent, and sometimes not getting to do what you want. When I meet people who tell me they want an open relationship with their partner with no rules and no partners off limits, I know we need to explore if this person wants a shared open relationship with their partner or do they want to no commitment at all. It is ok to want to make sexual decisions strictly for yourself and by yourself, but it helps to be clear about this. Otherwise what I have seen happen is an extended negotiation period in which one person continually breaks agreements, asks for more freedoms, and eventually the other person feels that there is no “relationship” at all, just free for all dating. If you want complete freedom from the boundaries and responsibilities of relationship, then that is a different conversation.

Explore the role sexuality plays in your life and your image of yourself. The more clarity you can have about your desires, fears, doubts, joys and yearnings, the more you will be able to have an intimate conversation with your partner about trying something new. Open relationships ask you to bring your sexuality out of the shadows and to talk about risky subject manner. Support yourself, know your own mind and heart as much as possible, and stay open and curious to what you are feeling. Working with a sex therapist or taking a workshop about sexuality can be a great resource.

Some days it takes all the attention we have to just figure out what it is that we are feeling, much less what we want to do about it. As a therapist, I want to honor that. This directive to say what you are feeling and speak your truth and be clear about what you need – not always easily achieved.

So what can you do when your thoughts are buzzing your head like angry dragonflies and your emotions are a jumbled ball of contradictory feelings and your intentions…who the hell knows?

First you can slow down. There is no rush to respond in the moment, unless the moment is a literal emergency and then you must trust your instincts. Stop talking and take a breath. Take another breath. Get out of your spinning head for a moment by simply looking around you. Find something beautiful in the space around you and look at it as though you were going to need to describe it later. Start to feel your body; it is there giving you structure. Move around a bit. OK, now that things are a bit slower…

You can identify the emotions without trying to figure them out. Just focus on the real basic emotions at first. You can say, “I am feeling angry.” Or “I am feeling really sad.” Or “I am feeling scared” Just start there. Don’t rush to explain why you are feeling that way, to yourself or anyone else, at the moment. Don’t justify your feelings by focusing on what that jerk did to make you feel that way, for now just identify the emotion or emotions. Just give yourself a bit of time to acknowledge those feelings as they are. Remind yourself that whatever you are feeling it is not going to last forever, it does not define you, and it is ok to feel it.

If you are with someone you care about, you might start by saying “I am feeling really sad right now and I want you to know that before we go further in talking about this.” This might help you avoid getting caught up in mental gymnastics and verbal sparring that is fed by unnamed emotions. Sharing how you feel also is an act of trust and openness and can soften the conversation for both of you. You can also say, “I need some time to figure out why I am having such strong emotions. I will come back to this conversation when I have more insight.”

Then give yourself a space to process all the thoughts and feelings and how they have gotten combined in such a potent mixture today. It is best if you can do this in a way in which you will not be held accountable for all that you are feeling in the moment. So talk it out with a neutral person who can understand conflicting and even irrational emotions sometimes need to be aired out. If you don’t have a person like that available, journal to yourself or talk to a mirror or close your eyes and talk to your divine or a departed loved one or a wise part of yourself. Clarity will come but it may take some dedicated time to explore the layers. Try to stay open to yourself.

We all get hit by big, confusing, overwhelming reactions sometimes. It helps to know that you don’t have to get stuck there or to have it all figured out immediately. Asking yourself, “What AM I feeling?!!” is actually a great start.

Sometimes summer gets all the love when it comes to sexiness. But cold weather sex can have its own enticements. Just think creatively…

What goes on under the blankets…Get into the private shared space underneath a heavy blanket. Enjoy the sensation of being bare under protective cover. Let your hands wander where you cannot see. Maybe you want to increase the cave-like vibe by going under and breathing in your shared smells and heat. Explore.

Oooh, those fuzzy socks… Or leather gloves or silky ties…Let your clothes get in on the act. Textures can be used to add new sensation to normal play. Use them when they are still on your body, stroking, brushing up against a sensitive spot. Then use them after you take them off. Ties and scarves are fun for gentle restraints or blindfolds. Gloves can make a nice little smack when used as a spanking toy. Socks…well, they are soft, just make sure they are clean (unless you are into that)

Make it hot…A sip of hot tea can become a part of sex play when you let it warm your mouth, then take that mouth somewhere sensitive. Gives whole new meaning to tea for two.

The sun is gone, to bed and so go I…dark nights, earlier bedtimes. Just saying.

Cue the soft lighting …Longer nights means more time for candlelight, firelight, twinkly strings of lights; all good choices if you are a bit shy and want to ease in to being seen in all your naked glory. Enjoy the opportunity to adjust the lighting to suit you and play with slow movements that cast shadows on the walls, slowing baring yourself, being illuminated in a pool of warm light.

Baby, it cold outside…which means each piece of skin you reveal to the elements will be very much alive and keenly responsive (so long as you are not in dangerous freezing conditions, of course). Use the variation of covered skin and uncovered skin wisely. Find a private spot where you can bare just enough to feel the shivery chills. Move vigorously to keep warm!

Who can do something to protect sexual health and sexual rights? You can.

It is time to get prepared.

Health care in general is going to get less accessible and chaotic. - If Obamacare is repealed, many of us are going to lose insurance and access the care. At best, things are going to get confusing and chaotic as massive shifts in plans, costs, and what we can expect go on around the nation. The gift of required coverage for pre-existing conditions may go away, leaving many Americans without coverage for long-term conditions. This applies to all manner of health, sexual and otherwise.

What you can do – it is hard to know how to prepare for this, since we don’t know what options will be available to us. If you have an issue you have been putting off getting care for, you may want to act. If you have a doctor you like and trust, you may want to see them now and ask about out of pocket payment options.

Birth Control is going to get less accessible – If people lose coverage for birth control (required under Obamacare), women will face monthly costs for prescriptions (estimated at $50 a month on average) putting added pressure on many individuals and families who may already be struggling. Getting a prescription may get a lot harder. Trump has said he will cut finding to Planned Parenthood, and Pence has personally led the fight to defund, which provides healthcare to 2.5 million people annually, and provides birth control for half of the women using contraceptives in the US. And we need to remember that hormonal birth control is not just for pregnancy prevention, it is used to treat symptoms of many other health issues, such as painful, problematic menstrual cycles. Effective use of hormonal birth control can preserve fertility and healthy reproductive systems for many women so that they can have healthy pregnancies later.

What you can do : For yourself, if you are thinking about longer term birth control options, like an IUD, tubal ligation, or vasectomy, now may be a good time to schedule with a doctor. If you use the pill or other monthly prescriptions, you may want to make room for that in your budget again.

For others – Donate to Planned Parenthood. Learn about low cost birth control options and spread the word. Teach your children to use condoms effectively and advocate for condoms to be available. Advocate for good accurate sex education that includes actual family planning information, not just abstinence.

More unplanned, unwanted pregnancies – Trump has made it clear he intends to reduce availability to abortion, both through his Supreme court appointees and through direct legislation. At a given time in America there are 43 million women who are sexually active and do not want to become pregnant. In 2011, 21 % of all pregnancies (excluding miscarriages) were ended with abortion. So that is a lot of people affected if abortion is no longer an option. I cannot address the impact on our communities of a massive increase in people being forced into parenting when they do not want that or of increased family sizes (59% of abortions are for women who had already given birth at least once).

What you can do : For yourself: be vigilant about birth control. Learn to use condoms effectively and be committed to your vision for your future.

For others : Donate to Planned Parenthood. Teach about effective birth control use, especially condom use. Talk to your kids about pregnancy prevention; do not rely on abstinence as the plan. Consider how to provide support for families who are faced with having children they do not feel prepared for, volunteer and donate to agencies that provide parenting support. Become aware and possibly support groups who are making abortion available, either by arranging travel to a place where it is available or supporting trained doctors. Become aware of dangerous procedures that people may try of they are desperate and speak out, educate about the risks.

Reduced rights for gay, lesbian, bi, and trans people – Trump has said that he is opposed to gay marriage and would consider appointing judges who will overturn gay marriage rights in the US. Earlier this year, Trump did state support for transgender people being able to use the bathroom they felt was appropriate but later said he would support individual states in deciding. Trump has said he will sign the First Amendment Defense Act, a very damaging ruling that allows for discrimination against GLBT citizens on the basis of religious beliefs. Vice President-elect Pence stated in 2000 that he felt funding for HIV research should be reallocated to provide programs for changing people’s sexual orientation to heterosexual (which has been banned by the APA as ineffective and unethical). The potential for increased harassment, discrimination, and danger for our communities seems clear.

What you can do : For yourself : Continue to be proud, to celebrate your love and relationships, and to refuse to be made invisible. Find allies and safe places in your community and go to them for support. Research legal steps to maintain your marital rights and protect your family. Stay aware of different states policies and be mindful when you travel or move.

For Others : Find and donate to a Diversity Center in your community. Educate yourself and your community about the issues and needs that the GLBT community faces. Speak up about discrimination or intimidation that you see. Volunteer for a suicide hotline. Volunteer at a homeless shelter, make sure the shelters in your area are safe for GLBT people. March, picket, physically show up to provide support and friendship and strength in numbers. Make sure your schools are providing support and safe spaces for queer kids.

Lack of safety and respect for women – it is hard to quantify the affect that having a President-elect who has openly ridiculed, harassed, and spoken about assaulting women, and is currently facing rape charges, has upon our country. I can say as a therapist, that simply witnessing Trump’s behavior and attitude for the past few months has re-traumatized many sexual assault survivors and been deeply disturbing for people who love and care about women’s dignity. The attitude, if not the legislation, is that women are fair game for objectification, molestation, and intimidation. It is also difficult to speak to the effect that so many white women voting for a man who so clearly disrespects women has had on many of us.

What you can do : For yourself : Find allies, women, men, and other gendered, who love and support you and stand with them. Get therapy support if you are feeling triggered or traumatized. Believe in yourself and your equality. Give yourself permission to say No, to get angry, to be an independent sexual being. Take up space, speak up, be yourself.

For others: Donate and volunteer for rape crisis centers and shelters in your communities. Volunteer for abuse hotlines. Work with kids to teach about consent and respect. Intervene if you see someone who looks like they are being victimized. Stop joking about or normalizing sexual harassment or objectification.

It is not time to give up. It is time to dig deep. It is time to pay attention. It is time to stand up for what you believe in and the future you want to see. Together we have made change happen before, together we can do it again.Be safe out there everybody. Take care of yourself and take care of each other.

I recently was told one of the myths of the Hindu Goddess Lakshmi, who is loosely the goddess of beauty (old world deities tend to be quite complex, not neatly categorized, but this is an aspect of Lakshmi which is very important, so excuse the simplification for now). The premise of the story was that when Lakshmi was ignored than beauty began to vanish from the world, fewer scented flowers, less sweet fruit on the vines, sunlight shined less brightly, and colors were less rich. This reminded me of a similar mythology regarding the African diety Oshun, who also rules and represents beauty and sweetness and pleasures in life. Oshun also is said to deeply desire to be noticed and when she is ignored, beauty fades from the world.

When I was younger I might have heard these stories as morality tales about the frivolity and insecurity of beauty. I would have seen them as a way to shame, specifically women, about wanting attention and reassurance that they were desirable. I would have heard in my head the male voice, lamenting that they had to keep telling their girlfriend that she was beautiful, as though this was work and shouldn’t be required of them. I would have drawn away from these archetypes thinking that they represented a weakness, rather than a gift.

But now I read this differently. Now I see two dieties, both bringing something vital to humanity – Beauty. Both wanting to be noticed. Or else. And it is the or else that matters. We need to notice or else we suffer without beauty in our life. We need to honor the beauty around us, or else we will miss it.

Now I see that stories tell us is if we do not make a point of honoring and acknowledging Beauty in our lives, we will have less of it. That beauty requires attention. Not for its own gain, but to exist. Beauty is in the eye of the beholder, truly. It is there for us when we notice it.

We can choose each day to notice beauty in our life, or not. To notice beauty in our partner, or not. To act on what beauty inspires in us, or not. To celebrate and revel in the pleasures of life, or not.

And now, as a couple’s therapist, I see the request to be noticed, to be seen, to be complimented as something much fundamental than frivolous. The request to be noticed, is a request to feed that energy, to keep it alive. It is a way of saying “give energy to the beauty I bring to your life, and this will help me keep this part of myself alive”. It is a way of saying, “I can give generously but you need to let me know what you want more of.” And I hope for my committed readers it goes without saying, that this is something men, women, and all genders need. Beauty is not exclusive to women. Beauty is a whole lot of things, as many unique possibilities as there are unique people to witness it.

Oh yeah baby, do you want more of that? Tell me…show me…

Energy needs to be replenished; apparently even for gods. All we have to do to nourish it, is notice and acknowledge what we see. How lucky for us. And our noticing and bringing attention and celebrating, brings more energy to the Beauty around us, and on and on. So as we enter this season of gratitude, I invite you to express yourself when you witness beauty of all kinds. Tell someone that they are beautiful to you. Touch your partner where they are so amazingly soft or so appealingly firm. Make some noise of appreciation. Stop and watch the colors of the sunset shift into the night sky, and point it out to someone so that they notice it too. And in this way, we keep Beauty alive and blessing us with more.

There are simply too many thoughts and feelings to express in regards to the recently released 2005 video of Trump and Billy Bush sexually harassing and hideously objectifying women. I frankly need to vent for a few more hours in private before I can offer something helpful to the conversation. But here is one aspect of the commentary about it that I want to address right now.

It is time that people stop saying, in regards to a woman being sexually victimized in any way, that she is deserving of protection because she is someone’s daughter, mother, sister, wife. Really? Really???!!! How about because she is a human being?! How about she is deserving of respect and personal rights by virtue of her existence?

This statement comes out so commonly after public instances of sexual abuse that we really need to finally call it out. If this is the best you can do in finding a reason to support women’s rights to personal safety, you are part of the problem. (To see what I am referring to watch the wonderful John Oliver’s monologue on this common response).

We need to acknowledge that the foundation of this statement is the fact that women were for centuries considered property of their fathers, husbands, or in some cases, brothers – MEN who were, by virtue of being male, deserving of respect. So to call out the relatives of a women as the reason we should protect her is drawing on the historic stance that women, on their own, do not have rights. “Don’t be upset for the pain and humiliation this caused the woman herself, but think about the pain it caused her respectable relatives”. We need to surround the woman with non-sexualized family members to consider her with compassion.

And let’s break that down, shall we? The underlying stance in this is that a sexual woman is not, on her own, deserving of protection or respect. We need to see her through the non-sexualizing eyes of her relatives to see her as worthy of human decency. If a woman is seen as sexual, we can’t expect men to control themselves around her - there she is with her attractive legs, ass, breasts, right there for us to see. Maybe if we can mask her sexuality in our minds by relating her to a non-sexual role (daughter, mother, sister), then we can see her as something other than an object of sexual desire. Because if we perceive her as an object of sexual desire then we automatically erase some of her personal rights to respect and safety. Do you see how messed up this is?!!

This system that has established a woman’s sexuality as an excuse to violate her rights is harmful to all of us. It continues to reverberate throughout our culture in many ways. Here it is in front of our faces, yet again. What will we all choose to do about it? When will we finally understand that women’s sexuality is not bad, immoral, an open invitation, a joke, a tease, a deficit, a manipulation, a sin, a toy, a taunt, a sign of weakness, a red mark, an embarrassment, a target, or a prize – a woman’s sexuality is a natural, healthy part of who she is and is hers to express or not.

Don’t protect me from sexual assault or harassment because you think my father or mother don’t deserve to have their daughter violated. Protect me from sexual assault because you respect me and believe I am deserving of protection. Because I am a human being.

…Oh, and if you are really truly shocked that men like Trump and Bush are out there acting like this with very few consequences, you haven’t been listening to women. But that is another post.

Here are a few ways I wish we could be more in agreement when it comes to sex.

1)The vast majority of your patients are having sex. And it is important to them. At least as important to many of them as their ability to play tennis or go for a jump shot or pick up their grandkids. So, since this is the reality, maybe you could include sexual health and satisfaction as a part of your wellness check? Maybe you could get comfortable talking to people about this aspect of their lives? At least don’t dismiss it or shame your patients for having concerns.

2)Most of the sex people will have in their life is not about procreation. We are having sex for many years of our lives and for many of reasons. Reproducing is a small part of only some of our sex lives. So treating reproductive health as though it is the same a sexual health is severely lacking. Issues such as long term birth control, hormone balance, sexual desire, pleasure and comfort are crucial to address.

3)Most medical concerns and their treatments have some effect on people’s sex lives. The diseases you diagnose take their toll on people’s sexual expression and can create real limitations. The drugs you prescribe can have significant sexual side effects that your patients’ may struggle with. The sexual aspects of Self are not separate from the medical concerns a person has or the journey they may need to take for healing. Please consider these aspects of your patients when you talk to us about treatment.

4)A large percentage of your patients are not heterosexual or monogamously married with children or clearly placed in some simplistic gender binary. For example, consistently statistics suggest that approximately 10% of the population is bisexual, lesbian or gay. I suspect that this number is low and reflects both a narrow categorization of sexual identity and also a long history of repression and fear of discrimination. But even if it was only 10%, denying the unique needs or rights of this group of people in our communities is discrimination plain and simple. And it is medically irresponsible. Get yourself informed.

5)You have blindspots and biases like the rest of us. We don’t expect you to be perfect so please don’t expect that of yourself. You most likely grew up with the same cultural models and mythologies as we did. You probably had very little accurate sex education. You probably have been hurt, betrayed, embarrassed, and confused about things, like the rest of us. So let’s agree that your years of medical school did not erase the limitations to your sexual perspective or understanding. That’s ok. You are allowed to not have all the answers, just acknowledge that and we can work with you from there.

6)Your job is to give us information so that we can make informed choices, not to make choices for us. No matter how much medical experience or training you have, you cannot know more than your patient does about the potential consequences and benefits of a decision in their life. Help us to understand our options, then honor that the personal factors at play on our lives are hugely relevant and frankly, outside of your scope. Respect what we know about our life.

Melissa Fritchle is the author of The Conscious Sexual Self Workbook and a Holistic Psychotherapist, licensed in California as a Marriage and Family Therapist (Lic#48627). She has a private practice specializing in Sex Therapy and Couples Therapy. She travels far and wide, internationally and on the internet, to spread compassionate, sex positive, diverse, realistic sex education.